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Adrenal Metastasectomy in the Era of Immuno- and Targeted Therapy

  • Endocrine Tumors
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Abstract

Adrenal metastasectomy has an increasing role in multimodality oncologic care for diverse primary cancer types. In this review, we discuss the epidemiology, evaluation, and contemporary best practices in the management of adrenal metastases from various primaries. Initial evaluation of suspected adrenal metastases should include diagnostic imaging to assess the extent of tumor involvement and determine surgical resectability, as well as biochemical evaluation for hormone secretion. Biopsy has a minimal role and should only be performed in tumors that are established to be non-hormone secreting and when the biopsy results would change clinical management. Adrenal metastasectomy is associated with survival benefit in selected patients. We suggest that adrenal metastasectomy has the greatest benefit in four clinical scenarios: (1) disease limited to the adrenal gland in which adrenalectomy renders the patient disease-free; (2) isolated progression in the adrenal gland in the setting of otherwise controlled metastatic extra-adrenal disease; (3) need for palliation of symptoms related to adrenal metastases; or (4) in the context of tissue-based clinical trials. Both minimally invasive and open adrenalectomy techniques are safe and appear to have equivalent oncologic outcomes. Minimally invasive approaches are favored when technically feasible while maintaining oncologic principles. A multidisciplinary evaluation including clinicians with expertise in the primary cancer type is essential to the successful management of adrenal metastases.

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Funding

Support was provided to HW from the National Institutes of Health National Cancer Institute grant #K08 CA270385.

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Authors and Affiliations

  1. Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Heather Wachtel MD

  2. Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Paxton Dickson MD

  3. Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sarah B. Fisher MD

  4. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Colleen M. Kiernan MD, MPH & Carmen C. Solórzano MD

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  1. Heather Wachtel MD
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Correspondence to Heather Wachtel MD.

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Heather Wachtel, Paxton Dickson, Sarah B. Fisher, Colleen M. Kiernan, and Carmen C. Solórzano declare no conflicts of interest.

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Wachtel, H., Dickson, P., Fisher, S.B. et al. Adrenal Metastasectomy in the Era of Immuno- and Targeted Therapy. Ann Surg Oncol 30, 4146–4155 (2023). https://doi.org/10.1245/s10434-023-13474-8

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